Suzanne Merrill, MD, on integrating ICIs into clinical practice for NMIBC

In a recent interview with Urology Times®, Suzanne B. Merrill, MD, FACS, discussed the feasibility of integrating immune checkpoint inhibitors (ICIs) into clinical practice for non–muscle invasive bladder cancer (NMIBC), particularly in the community setting. Several of these agents are currently under investigation in combination with BCG for BCG-naïve NMIBC, including sasanlimab in the phase 3 CREST trial (NCT04165317), durvalumab in the phase 3 POTOMAC trial (NCT03528694), and atezolizumab in the phase 3 ALBAN trial (NCT03799835).

According to Merrill, “[This is something that] we're all going to have to address. These agents are going to be FDA approved; it's just a matter of time.”

Merrill is a urologic oncologist at Colorado Urology.

Merrill explained that large urology group practices that already manage infusion-based treatments for advanced prostate cancer will likely adopt ICIs more easily. These practices already have infusion suites, trained nurses, and operational systems in place. Their main challenge, she said, will be becoming comfortable with managing immune-related adverse effects, which differ from those seen with current drugs for advanced prostate cancer.

In contrast, smaller community practices may face greater challenges due to limited infrastructure for infusions and specialized staff. However, the subcutaneous formulation of sasanlimab could improve accessibility by reducing the need for infusion facilities. Merrill did caution, though, that despite being easier to administer, subcutaneous ICIs carry the same safety risks as intravenous ICIs.

Merrill concluded, “We'll need to ensure that the managing of these [adverse] effects doesn't get overlooked with the ease of the administration of some of these subQ formulations. I think, ultimately, subQ formulations will allow some of these smaller practices to start to integrate this earlier than if we were completely restricted to only using IV or infusion ICIs.”